Adoption Application

Animal Desired:

Date:

Your Name:

Address:

Home Number:

Work Number:

Email Address:

Please describe your living arrangement:

Do you own? Rent? Live with parents or relatives?

Please tell us more...

If renting, Landlord's Name

Landlord's Number

How much money do you expect to spend yearly on a pet that you adopt?

List below the pets that you currently own:

Pet #1
Type of animal/breed:
Male Female	Spayed/Neutered? Yes No
Indoor Outdoor	Current Vaccinations? Yes No
How old?

Pet #2
Type of animal/breed:
Male Female	Spayed/Neutered? Yes No
Indoor Outdoor	Current Vaccinations? Yes No
How old?

Pet #3
Type of animal/breed:
Male Female	Spayed/Neutered? Yes No
Indoor Outdoor	Current Vaccinations? Yes No
How old?

Previous/current veterinarian:

Phone number:

Please list the type and breed of pets that you have previously owned in the last 10 years:

#1
Type of animal/breed:
Age:	How long owned?
What happened to him or her?

#2
Type of animal/breed:
Age:	How long owned?
What happened to him or her?

#3
Type of animal/breed:
Age:	How long owned?
What happened to him or her?

Do you plan to spay or neuter the pet you adopt? Yes No

This pet will be: Indoor only Indoor and outdoor Outdoor only

Where will this pet be kept during the day?

During the night?

I certify that all of the above information is true. I also understand that giving false information in this application is grounds for denying my application. This application remains the property of Murrayhill Veterinary Hospital.

Applicant Name:

Driver's License/ID #:

** Please note that we can only guarantee the privacy of your information after we receive it. However, we cannot guarantee such privacy during this form's transport across the internet. If you prefer, you can also print this form and deliver it personally or by mail.